Become a Provider

Provider Application Process
Public or private non-profit organizations are eligible to apply for funding through the Ryan White HIV Services Program. Non-profit service providers must be able to document proof of non-profit status through appropriate documentation (i.e., a Letter of Determination issued by the Internal Revenue Service stating non-profit status). If a service provider does not wish to enter into a long-term contractual agreement for service provision, other options, such as a memorandum of understanding or business associates agreement may be discussed with the Ryan White HIV Services Program Director.

See the current Ryan White HIV Services Program providers here.

• The following 4 documents are required to be completed for application for Part A/MAI funds for 2022-2023:  Part A/MAI Request for Professional Services 2023-2024; Attachment A-Cost per unit template (this is an example); Attachment B-Requested Service Form; Attachment C-Budget Forms; Attachment D-Time and Effort Form for Subrecipients.  The following 2 documents are for reference in completing the Request for Professional Services:  PCN 16-02 HRSA Service Definitions; CAREWare Data Requirements (HRSA dot grid).

The following documents provide information on Program Income and are useful reference materials for preparation of applications:

• HRSA PCN 15-03, Program Income
• HRSA PCN 15-04, Pharmaceutical Rebates
• HRSA PCNs 15-03 and 15-04, Frequently Asked Questions
• Program Income Guidance and FAQs for Ryan White Part B and Parts A/C/MAI, Update
• Program Income Infographic
• Imposition of Charges Infographic
• Program Income Tracker Template IDOH-MCPHD
• Program Income Spending Plan Template for Part B and Parts A/C/MAI

There will be an online informational meeting for applicants on October 21, 2022 from 10am-11am. Instructions to join by Webex are included on page one of the Part A/MAI Request for Professional Services 2023-2024 posted above.  Proposals for Part A/MAI funds for 2023-2024 must be emailed to achooks@marionhealth.org no later than 12:00P.M. (Noon), November 18, 2022.  It is essential that all requested information is received by the deadline date and time. Proposals received after the deadline will not be considered for funding.